Should We Pay New Moms to Breastfeed?

While breastfeeding might be natural, for plenty of moms it doesn’t come naturally. The American Academy of Pediatrics (AAP) recommends that moms breastfeed until baby’s first birthday and exclusively for the first six months. But although over 82 percent of American moms initiate breastfeeding at birth, only 55 percent are still breastfeeding by 6 months (25 percent exclusively), and only 34 percent make it through the full first year, according to 2014 data from the Centers for Disease Control and Prevention (CDC). Of course there are many reasons new moms find nursing challenging — including lack of support from health care providers. But a new study published in JAMA Pediatrics suggests that offering financial incentive to nurse might encourage new moms to breastfeed longer.

What the study looked at

In the U.K., breastfeeding rates are among the lowest in the world, with just 12 percent of moms in some areas breastfeeding at six to eight weeks postpartum despite many attempts to encourage nursing. So researchers recruited more than 10,000 British mothers with babies born between February 2015 and February 2016 who lived in areas where less than 40 percent of moms breastfeed when their newborns are six to eight weeks old.

All of the moms received "usual" maternity and infant feeding care per the UNICEF U.K. Baby Friendly Initiative standards — a set of guidelines intended to encourage breastfeeding when they checked in with healthcare providers at 2 days, 10 days, 6 to 8 weeks, 3 months and 6 months postpartum. About half (5,398) were offered £40 ($50) vouchers at each check-in if they signed a form with their doctor confirming they were breastfeeding. (They were also offered the opportunity to mail in a form saying that their babies hadn’t actually been breastfed without the risk of the voucher being taken away.) The other half (4,612) received the same standard postpartum care but were not offered vouchers.

The researchers then compared how many moms in each group were breastfeeding at six to eight weeks postpartum, accounting for breastfeeding rates in their local areas. (Past research has suggested that being surrounded by family and friends who have breastfed themselves can be a powerful source of social support that influences whether a mom continues nursing herself.)

What it found

Compared to moms who weren’t offered the vouchers, moms who received financial incentive were nearly 6 percent more likely (32 percent to 38 percent) to be breastfeeding when their babies were six to eight weeks old. So the impact was relatively modest, and it was limited: Receiving a voucher didn’t make moms more likely to initiate breastfeeding or to be breastfeeding exclusively at six to eight weeks postpartum.

What this means for moms

In areas where moms are less likely to breastfeed, offering a financial incentive may help encourage more moms to breastfeed for longer. However there were some flaws with the study. Notably, it asked moms to report themselves whether or not they were breastfeeding — and moms who are struggling to get by may have, with good reason, been tempted to say they were nursing when they really weren’t just to receive the voucher. Still, the authors say this is the first study to show a program that encouraged a real increase in breastfeeding in areas where rates are lower than average.

Breastfeeding has lots of benefits for mom (including speedier postpartum recovery and natural birth control) and for baby (including reduced risk of allergies, obesity and protection from infection). But again, many women face breastfeeding problems like mastitis, a poor latch and mouth problems — although many of these are surmountable with help from an expert. So if you’re struggling to breastfeed, know that your health insurer is required by law to provide breastfeeding support, including help from a lactation consultant and a breastfeeding pump, at no cost to you.

And remember that ultimately breastfeeding is a choice. If it’s not the right one for you, don’t feel guilty. What babies really need to grow up strong and healthy is your love and attention.